scholarly journals Gender-stratified analyses of symptoms associated with acute coronary syndrome in telephone triage: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e042406
Author(s):  
Loes T C M Wouters ◽  
Dorien L M Zwart ◽  
Daphne C A Erkelens ◽  
Esther De Groot ◽  
Maarten van Smeden ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cross Sectional Study ◽  
Primary Outcome Measure ◽  
Sectional Study ◽  
Chest Discomfort ◽  
Cross Sectional ◽  
Gender Interaction ◽  
Coronary Syndrome ◽  
Registration Number ◽  
Multivariable Analyses

ObjectivesTo identify clinical variables that are associated with the diagnosis acute coronary syndrome (ACS) in women and men with chest discomfort who contact out-of-hours primary care (OHS-PC) by telephone, and to explore whether there are indications whether these variables differ among women and men.DesignCross-sectional study in which we compared patient and call characteristics of triage call recordings between women with and without ACS, and men with and without ACS.SettingNine OHS-PC in the Netherlands.Participants993 women and 802 men who called OHS-PC for acute chest discomfort (pain, pressure, tightness or discomfort) between 2014 and 2016.Primary outcome measureDiagnosis of ACS retrieved from the patient’s medical record in general practice, including hospital specialists’ discharge letters.ResultsAmong 1795 patients (mean age 58.8 (SD 19.5) years, 55.3% women), 15.0% of men and 8.6% of women had an ACS. In both sexes, retrosternal chest pain was associated with ACS (women with ACS vs without 62.3% vs 40.3%, p=0.002; men with ACS vs without 52.5% vs 39.7%, p=0.032; gender interaction, p=0.323), as was pressing/heavy/tightening pain (women 78.6% vs 61.5%, p=0.011; men 82.1% vs 57.4%, p=<0.001; gender interaction, p=0.368) and radiation to the arm (women 75.6% vs 45.9%, p<0.001; men 56.0% vs 34.8%, p<0.001; gender interaction, p=0.339). Results indicate that only in women were severe pain (65.4% vs 38.1%, p=0.006; gender interaction p=0.007) and radiation to jaw (50.0% vs 22.9%, p=0.007; gender interaction p=0.015) associated with ACS.Ambulances were dispatched equally in women (72.9%) and men with ACS (70.0%).ConclusionOur results indicate there were more similarities than differences in symptoms associated with the diagnosis ACS for women and men. Important exceptions were pain severity and radiation of pain in women. Whether these differences have an impact on predicting ACS needs to be further investigated with multivariable analyses.Trial registration numberNTR7331.

scholarly journals Chest discomfort at night and risk of acute coronary syndrome: cross-sectional study of telephone conversations

2020 ◽  
Vol 37 (4) ◽  
pp. 473-478 ◽  
Author(s):  
Loes T Wouters ◽  
Dorien L Zwart ◽  
Daphne C Erkelens ◽  
Noël S Cheung ◽  
Esther de Groot ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Risk Ratio ◽  
Patient Characteristics ◽  
Final Diagnosis ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Chest Discomfort ◽  
Cross Sectional ◽  
Adjusted Risk ◽  
Coronary Syndrome

Abstract Background During telephone triage, it is difficult to assign adequate urgency to patients with chest discomfort. Considering the time of calling could be helpful. Objective To assess the risk of acute coronary syndrome (ACS) in certain time periods and whether sex influences this risk. Methods Cross-sectional study of 1655 recordings of telephone conversations of patients who called the out-of-hours services primary care (OHS-PC) for chest discomfort. Call time, patient characteristics, symptoms, medical history and urgency allocation of the triage conversations were collected. The final diagnosis of each call was retrieved at the patient’s general practice. Absolute numbers of patients with and without ACS were plotted and risks per hour were calculated. The risk ratio of ACS at night (0 to 9 am) was calculated by comparing to the risk at other hours and was adjusted for gender and age. Results The mean age of callers was 58.9 (standard deviation ±19.5) years, 55.5% were women and, in total, 199 (12.0%) had an ACS. The crude risk ratio for an ACS at night was 1.80 (confidence interval 1.39–2.34, P &lt; 0.001): 2.33 (1.68–3.22, P &lt; 0.001) for men and 1.29 (0.83–1.99, P = 0.256) for women. The adjusted risk ratio for ACS of all people at night was 1.82 (1.07–3.10, P = 0.039). Conclusions Patients calling the OHS-PC for chest discomfort between 0 and 9 am have almost twice a higher risk of ACS than those calling other hours, a phenomenon more evident in men than in women. At night, dispatching ambulances more ‘straightaway’ could be considered for these patients with chest discomfort. Trial number NTR7331.

Chest discomfort at night and risk of acute coronary syndrome: cross-sectional study of telephone conversations

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711317
Author(s):  
Loes Wouters ◽  
Dorien Zwart ◽  
Carmen Erkelens ◽  
Esther de Groot ◽  
Roger Damoiseaux ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Risk Ratio ◽  
Patient Characteristics ◽  
Final Diagnosis ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Chest Discomfort ◽  
Cross Sectional ◽  
Adjusted Risk ◽  
Coronary Syndrome

BackgroundDuring telephone triage it is difficult to assign the adequate urgency to patients with chest discomfort. Considering the time of calling could be helpful.AimTo assess the risk of acute coronary syndrome (ACS) in certain time periods and whether sex influences this risk.MethodCross-sectional study of 1,655 recordings of telephone conversations of patients who called the out-of-hours services primary care (OHS-PC) for chest discomfort. Call time, patient characteristics, symptoms, medical history and urgency allocation of the triage conversations were collected. The final diagnosis of each call was retrieved at the patient’s general practice. Absolute numbers of patients with and without ACS were plotted and risks per hour were calculated. The risk ratio of ACS at night (0 am to 9 am) was calculated by comparing to the risk at other hours, and was adjusted for gender and age.ResultsThe mean age of callers was 58.9 (SD ± 19.5) years, 55.5% were women and in total, 199 (12.0%) had an ACS. The crude risk ratio for an ACS at night was 1.80 (CI = 1.39 to 2.34, P<0.001); 2.33 (1.68 to 3.22, P<0.001) for men, and 1.29 (0.83 to 1.99, P = 0.256) for women. The adjusted risk ratio for ACS of all people at night was 1.82 (1.07 to 3.10, P = 0.039).ConclusionPatients calling the OHS-PC for chest discomfort between 0–9 am have almost twice a higher risk of ACS than those calling other hours, a phenomenon more evident in men than in women. At night, dispatching ambulances more ‘straightaway’ could be considered for these patients with chest discomfort.

scholarly journals Frequency of CYP2C19*2 Allele in Patients with Acute Coronary Syndrome: A Cross-sectional Study from Central Kerala, India

2021 ◽  
Author(s):  
Christina Ann George ◽  
Shibu Thadathil Sreedharan ◽  
Smitha Kalarikkal Satheesan ◽  
Sindhu Panakkaparambil Surendranath
Keyword(s):  
Acute Coronary Syndrome ◽  
Cross Sectional Study ◽  
Government Medical College ◽  
Sectional Study ◽  
Therapy Failure ◽  
Cross Sectional ◽  
Medical College ◽  
Coronary Syndrome ◽  
Variant Genotype ◽  
Study Population

Introduction: Ischaemic Heart Diseases (IHD) are increasing at an alarming rate globally. Pharmacotherapy, the mainstay of management of IHD, has Dual Antiplatelet Therapy (DAPT) at its crux. DAPT, comprising of clopidogrel and aspirin, is used often for 12 months in medically managed Acute Coronary Syndrome (ACS). Clopidogrel being a prodrug, needs to be activated after ingestion, mainly by Cytochrome family of enzymes, for the desired pharmacological effects. Abnormal enzymes that convert clopidogrel to its active form can reduce the effectiveness of the drug. Therefore, Single Nucleotide Polymorphisms (SNPs) of the enzymes involved, would predispose the patient to therapy failure and recurrence of the illness. This study aims at identifying the presence of a genetic variant associated with clopidogrel responsiveness in patients with ACS. Aim: To estimate the frequency of CYP2C19*2 allele in patients with ACS presenting to Government Medical College, Thrissur, Kerala, India. Materials and Methods: Present study was a cross-sectional study done among 60 patients who presented to Government Medical College, Thrissur with ACS, between June 2018 to June 2019. Having obtained informed consent from the participants blood samples were collected in Ethylene diamine tetra-acetic Acid (EDTA) tubes. Samples were used to look for presence of CYP2C19*2 allele by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP). Results: Out of 60 patients 38 were males and 22 were females. Most common age group was 61-65 years. The frequency of CYP2C19*2 allele was 41% in the study population and the variant genotype (AA/AG) was present in 62%. Conclusion: The variant genotype was found to be present in a high frequency in the study population implying the high risk for therapy failure in the study population. This asserts the need to probe the matter further, as the gene is also implicated in the metabolism of several other drugs. The introduction of pharmacogenomic testing prior to initiation of therapy may be therefore recommended for better treatment outcome. However, to validate the same, further studies with larger sample size may be necessary.

scholarly journals Depression in Acute Coronary Syndrome Patients: A Cross-sectional Study in Malaysia

2020 ◽  
Author(s):  
Wan Nor Asyikeen Wan Adnan ◽  
Siti Azrin Ab Hamid ◽  
Zatul Rathiah Sulong ◽  
Mohd Hashairi Fauzi
Keyword(s):  
Acute Coronary Syndrome ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Female Gender ◽  
Cross Sectional Study ◽  
Ischemic Heart ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Associated ◽  
Coronary Syndrome

Background and purpose: Linked with high mortality rate, depression is common among acute coronary syndrome (ACS) patients. The current study sought to identify the factors associated with depression among ACS patients in Malaysia. Materials and Methods: A cross-sectional study was conducted on 400 ACS patients in two Malaysian hospitals: Hospital Universiti Sains Malaysia (USM), Kelantan and Hospital Sultanah Nur Zahirah (HSNZ), Terengganu. ACS patients were included if they were above 18 years of age, able to read and/or write in Bahasa Melayu language and had informed consent. Patients were excluded if they were intubated, had an altered mental status, mental retardation and had psychological problems prior to ACS. Depression in this study was defined as having dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest or involvement, anhedonia, and inertia among ACS patients. A questionnaire was distributed to all 400 ACS patients. Simple and multiple logistic regressions were used for data analysis. Results: The mean (standard deviation) age of ACS patients was 60.4 (11.3) years at Hospital USM and 61.2 (10.4) years at HSNZ. Nearly all of the depressive-ACS patients were Malay (79.4%), 85.9% were male, and 79.7% were married. Approximately 87.7% of depressive-ACS patients had ischemic heart disease, 87.1% had stroke, 83.4% had hyperlipidaemia, 81.8% had diabetes mellitus, and 80.7% had hypertension. The factors associated with depression were female gender (adjusted odd ratio (OR): 2.48, 95% confidence interval (CI): 1.50, 4.10, p<0.001) and ischemic heart disease (adjusted OR: 2.44, 95% CI: 1.41, 4.25, p=0.002). Conclusion: The results showed that female gender and ischemic heart disease were the most significant associated factors of depression among ACS patients.

scholarly journals Cross-Sectional Study of Patients With Onset of Acute Coronary Syndrome During Statin Therapy

2015 ◽  
Vol 7 (5) ◽  
pp. 324-331
Author(s):  
Nobuhiro Akuzawa ◽  
Takashi Hatori ◽  
Kunihiko Imai ◽  
Yonosuke Kitahara ◽  
Masahiko Kurabayashi
Keyword(s):  
Acute Coronary Syndrome ◽  
Statin Therapy ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Coronary Syndrome

scholarly journals Influence of socioeconomic status on the referral process to cardiac rehabilitation following acute coronary syndrome: a cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. e036088
Author(s):  
Christina Boesgaard Graversen ◽  
Martin Berg Johansen ◽  
Regina Eichhorst ◽  
Søren Paaske Johnsen ◽  
Sam Riahi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Educational Level ◽  
Cross Sectional Study ◽  
Referral Process ◽  
Willingness To Participate ◽  
Sectional Study ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
Three Phases

ObjectiveTo evaluate the association between socioeconomic status (SES) and referral to cardiac rehabilitation (CR) after incident acute coronary syndrome (ACS) by dividing the referral process into three phases: (1) informed about CR, (2) willingness to participate in CR, (3) and assigned CR setting.DesignCross-sectional study.SettingDepartment of Cardiology at a Danish University Hospital from 1 January 2011 to 31 December 2014.ParticipantsA total of 1229 patients assessed for CR during hospitalisation with ACS were prospectively registered in the Rehab-North Register from 2011 to 2014. SES was assessed using data from national registers, concerning: personal income, occupational status, educational level and civil status. Patients were excluded if one of the following criteria was fulfilled: (1) missing data on SES, or (2) acceptable reason for not informing patients about CR (treatment with coronary artery bypass grafting, transfer to another hospital, still under treatment or death).Main outcome measuresOutcomes were defined by dividing the referral process into three phases: (1) informed about CR, (2) willingness to participate, and (3) assigned CR setting (in-hospital/community centre) after ACS.ResultsA total of 854 (69.5 %) patients were referred to CR. After adjustment for age, gender, ACS diagnosis (ST-elevated myocardial infarction, non-ST-elevated myocardial infarction, unstable angina pectoris) and comorbidity, high income had the strongest association of referral to CR in all three phases (informed about CR: OR 2.17, 95% CI 1.01 to 4.64; willingness to participate in CR: OR 1.55, 95% CI 1.02 to 2.35; assigned in-hospital CR: OR 1.47, 95% CI 0.91 to 2.36). Educational level showed similar tendencies, however not statistically significant. The results did not vary according to gender.ConclusionThis is the first study to investigate the referral process to CR using a three-phase structure. It suggests income and education to influence all phases in the referral process to CR after ACS.

Sex differences in the management of patients with acute coronary syndrome: A population-based ecological cross-sectional study in Spain

2020 ◽  
Author(s):  
Juan Miguel Ruiz-Nodar ◽  
José Luis Ferreiro ◽  
Aida Ribera ◽  
Josep Ramón Marsal ◽  
José María García Acuña ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Sex Differences ◽  
Population Based ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Coronary Syndrome
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